Author: Karen Veazey
Shingles, also known as herpes zoster, is a type of rash that occurs due to the varicella-zoster virus (VZV). Although shingles usually resolve after a few weeks, complications can develop that affect the nerves, ears, eyes, or organ systems.
VZV is the virus that causes chickenpox. After chickenpox resolves, the virus lies dormant and can later reactivate, resulting in shingles. Shingles appear as small, painful blisters that develop on one side of the body or face.
Shingles generally resolve 2 to 4 weeks after blisters develop, sometimes leaving behind scarring and pigment changes on the skin.
This article describes complications that some people can develop following a shingles infection. These complications include long-term pain, eye or ear problems, or serious illness.
Shingles blisters typically form on one side of the body or face. Commonly, the rash first appears wrapped around the waist on one side.
According to the National Institute on Aging (NIA) symptoms of shingles may include:
- small, fluid-filled blisters
- burning or shooting pain at the rash site
- tingling, itching, or numbness
- nausea or stomach problems
The severity of shingles symptoms can vary from mild to very painful.
A rash on the face can cause long-term vision or hearing problems or brain inflammation. The NIA recommends seeing a doctor right away if a person has shingles on their face.
Although shingles usually resolve in 2–4 weeks, some people may develop complications, including:
Post-herpetic neuralgia (PHN)
The most common complication is PHN, which results in nerve pain in the area where shingles have occurred. It develops in about 20% of people who have had shingles and is more common in those over 50 years of age. It can also occur during an active shingles infection.
This nerve pain may be intermittent or continuous. It can be stabbing, shooting, burning, achy, throbbing, or feel like a shock.
PHN can also cause small things that do not typically cause pain, such as a gentle touch or cool wind, to hurt. The area may generally be more prone to feeling pain.
PHN often resolves within 1 year after first appearing, and it may take longer or can be permanent in some people.
When shingles develop near or on the eye, including the forehead and nose, it can lead to infections on the eye’s surface. In some cases, this can lead to temporary or permanent vision loss.
If shingles are present on the face or if there is redness or swelling of the eye, a person should seek medical attention.
Shingles near the ear or on the face can affect hearing and balance and, in some cases the use of facial muscles.
If shingles develop on the face or head near the ear or within the ear itself, an individual should seek medical attention.
Swelling of the brain
Although it is rare shingles can spread to the brain and cause encephalitis, or brain inflammation. It can also lead to meningitis, an infection of the brain or spinal cord, or stroke.
If a person scratches open the blisters of a shingles rash, they may develop an infection. Infections often involve Staphylococcus aureus or group A beta hemolytic Streptococcus bacteria.
Vasculopathy and stroke
The virus that causes shingles can trigger the immune system and cause inflammation on the surface of blood vessels, known as vasculopathy.
For several months following a shingles breakout and particularly in the first few weeks following vasculopathy, the risk of stroke increases by as much as 5%.
While healthcare professionals prescribe antivirals to help prevent PHN, they can also recommend various treatments for the complications of shingles. Below are treatments for each complication.
Treatment for PHN involves medication. Doctors may prescribe one or more medications from the following drug classes:
- Tricyclic antidepressants (TCAs): Newer TCAs can be effective for nerve pain and have fewer side effects than older TCAs. However, people with heart arrhythmias, a history of heart attack, or glaucoma should not take them.
- Anticonvulsants: Misfiring nerve cells are a common link between seizures and nerve pain. Anticonvulsants, such as gabapentin, can calm these nerve impulses.
- Opioids: Although opioids effectively block pain, they are addictive, and doctors will carefully monitor how a person uses them.
- Topical local anesthetics: Lidocaine is the topical anesthetic doctors most often prescribe to ease nerve pain. Topical anesthetics do not cause systemic side effects such as drowsiness.
- Capsaicin: An active component of chili peppers, it serves as a topical option for PHN.
The goal of medication is to reduce nerve pain with minimal side effects.
Shingles of the eye
Shingles that spread to the eye require prompt treatment to prevent vision loss.
Oral antivirals that a person takes within 72 hours after the first symptoms are effective at preventing long-term complications. Some common antivirals include acyclovir, valacyclovir, and famciclovir.
Treatment with corticosteroids is controversial. They can effectively treat pain and rash but can cause a rebound effect when a person stops using them.
Dry eye can further complicate healing. Doctors may suggest artificial tears, punctal plugs, bandage contact lenses, eyelid reconstructive surgery, and tarsorrhaphy — this involves the joining of part or all of the eyelids.
Doctors can treat shingles on the eye, which they call herpes zoster ophthalmicus, with oral antivirals and topical steroid drops. They will need to perform an eye exam using a slit lamp to examine the cornea.
Shingles of the ear
Doctors prescribe antiviral medications to treat shingles of the ear, which is also known as Ramsay Hunt Syndrome. Common antivirals include acyclovir, valacyclovir, famciclovir, and prednisone. Antivirals can successfully prevent further nerve degeneration and other long-term complications.
Encephalitis and vasculopathy
Doctors prescribe intravenous acyclovir to treat encephalitis and vasculopathy.
A person may receive acyclovir intravenously, through a vein, for a few days, then continue a course of oral acyclovir at home. The treatment period lasts 7–14 days.
A history of chickenpox is the greatest risk factor for shingles. The chickenpox virus lies dormant in the body until it reactivates, causing painful shingles.
The second greatest risk factor is age. People over the age of 50 years are at increased risk of developing a shingles infection. Doctors recommend that people over this age or those over 19 years of age with weakened immune systems get the shingles vaccine.
People with compromised immune systems are more likely to develop complications from shingles, including PHN.
When to contact a doctor
If shingles develop near an eye or ear, a person should seek immediate medical attention.
They should also contact a doctor if they have nerve pain in an area of the body where the shingles rash does not appear.
If PHN is causing sleeplessness, depression, anxiety, or any other symptoms an individual can discuss this with a doctor.
With prompt treatment, the outlook is generally good for people with shingles complications. Medications are available to ease pain and help control symptoms, although they may produce some side effects.
The pain and discomfort from PHN may take up to 1 year to resolve.
The herpes zoster virus causes shingles — the same virus that causes chickenpox. After a person contracts chickenpox, the virus lies dormant in the body until it reactivates and produces small, painful blisters on one side of the body.
Shingles can cause complications, particularly if blisters form near the eye or ear or on the face. It can also lead to PHN, which causes painful nerve sensations. Doctors often prescribe oral antiviral and corticosteroid medication.
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